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Magalhães P, Gonçalves M, Silva F, Fernandes T, Oliveira A, Veríssimo R. Implementation of Orthogeriatrics in Portugal. Cureus 2023; 15:e35361. [PMID: 36974254 PMCID: PMC10039731 DOI: 10.7759/cureus.35361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Orthogeriatrics is the subspecialty of geriatrics that is dedicated to the care of elderly patients with fragility fractures. The Orthogeriatrics Unit of the Vila Nova de Gaia Hospital Centre was the first unit created in Portugal in October 2015, in a co-management model. METHODS Patients older than 65 years and with femur fractures were admitted to the unit after surgery. The department was run by internists with differentiation in geriatrics, and multidisciplinary support from orthopaedics, physiatrists, physiotherapists, nutritionists, and social workers, as well as rehabilitation nursing. A comprehensive multidisciplinary assessment was performed upon admission, including comprehensive geriatric assessment as well as postoperative monitoring of complications, investigation of fall mechanisms, functional rehabilitation, and outpatient orientation. Analysed variables included demographics, comorbidities, prior level of functionality, delay of orthopaedic surgery, complications, time of hospitalization, functional prognosis, and destination after discharge. Follow-up was maintained to assess short- and medium-term mortality. Kaplan-Meier curves and Cox regression were used for the statistical analysis of mortality. RESULTS In four years of activity with 444 admissions, the typical patients were women (80.7%), with an average age of 84 years, coming from home (92%) after an accidental fall resulting in a proximal femur fracture. About half (54%) were previously autonomous, but with a high index of comorbidities (mean Charlson Index of 4.85), the most relevant of which were arterial hypertension (71%), malnutrition (46%), heart failure (35%), hyperlipidaemia (34%), osteoporosis (32%), and dementia (16%). During hospitalization, most patients had medical complications (86.3%), the most frequent ones being anaemia (45%), infections (35%), namely, urinary, respiratory, and surgical wound infections, acute heart failure (15%), and acute kidney injury (11%). Prevalent geriatric syndromes were also identified and corrected through protocols for delirium, urinary incontinence, pressure ulcers, and constipation. The mean length of stay was 12.49 days. At discharge, 75% presented a modified Rankin Scale score lower than 3 and 73% of patients were able to return home, with a low referral rate to long-term care facilities (5.9%). The in-hospital mortality rate was 2.65%. It was possible to maintain follow-up protocol after discharge in 343 patients, and the mortality at 12 months was 19.23% and at three years, it was 25.52%, with a risk of death almost doubled for patients discharged with a high degree of dependence (modified Rankin Scale score ≥ 3; OR: 2.19; p < 0.001). CONCLUSION We demonstrated reduced in-hospital mortality despite an elderly, frail population, with multiple previous comorbidities and a high number of inpatient intercurrences evidencing the importance of a good in-hospital co-management between internal medicine and orthopaedics, demonstrating the benefit of orthogeriatric units in patients with fragility fractures of the femur.
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Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures. Rev Clin Esp 2021; 222:73-81. [PMID: 34548255 DOI: 10.1016/j.rceng.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. MATERIALS AND METHODS This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017). RESULTS The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17). CONCLUSIONS The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-De Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179407. [PMID: 34502013 PMCID: PMC8431020 DOI: 10.3390/ijerph18179407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007–2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups’ weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia 31, 39340 Suances, Spain;
| | - Ana Fernández-Feito
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Avda. Julián Clavería s/n, 33006 Oviedo, Spain
- ISPA, Nursing Research Group, Health Research Institute of Asturias, Avda. del Hospital Universitario s/n, 33011 Oviedo, Spain
- Correspondence:
| | - David Cantarero
- Department of Economics, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, Research Group of Health Economics and Health Services Management, Research Institute Marqués de Valdecilla, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Joaquín Cayón-De Las Cuevas
- Faculty of Law, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - María Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
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Development and implementation of a perioperative management guide for patients with hip fracture: Health management and clinical impact. ACTA ACUST UNITED AC 2021. [PMID: 34112450 DOI: 10.1016/j.recote.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hip fracture (HF) in the elderly has a high prevalence and risk of morbidity and mortality in the short and long term. It can reduce life expectancy by almost 2 years, and require permanent socio-sanitary assistance in one in 5 patients. Its management as a process where the patient takes priority over the activities of the organisation can bring new perspectives, optimisation tools and redesign of the workflow to make it more efficient. OBJECTIVE to develop an in-hospital clinical guide for the management of patients with HR adapted to the environment, clear and concise, to be able to intervene in the best possible conditions and favour their adequate recovery. MATERIAL AND METHODS 407 patients divided into 3 groups: pre-implementation (knowing the scope of the problem and areas for improvement); implementation (after the development of the management guide) and post-implementation (valued its implementation). RESULTS The clinical results obtained with this guide allowed improving surgical programming and reducing delay times (increasing the proportion of patients operated in the first 48h and reducing the average hospital stay in 3 days), raising awareness of the problem at all Services involved, improve the management of drugs that altered hemostasia, optimise transfusion therapy and reduce hospital stay and perioperative complications. CONCLUSION The implementation of this guide, with integrated global criteria, has improved the results of this process, and achieved a more efficient management, reducing the consumption of resources and as a consequence, health expenditure.
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Desarrollo e implementación de una guía de manejo perioperatorio de pacientes con fractura de cadera: gestión sanitaria e impacto clínico. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival. Braz J Phys Ther 2019; 24:479-487. [PMID: 31378633 DOI: 10.1016/j.bjpt.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study the adherence of an Early Inpatient Exercise Program in patients with acute hip fracture, identify variables associated with its performance, and its association to one-year survival. METHODS Observational longitudinal study of a cohort of 509 patients, admitted consecutively with a hip fracture in La Paz University Hospital (Madrid, Spain). Data included sociodemographic variables, pre-fracture physical functioning, cognitive impairment, comorbidities, measure of exercise adherence (pre-surgery exercise, post-surgery exercise, and rehabilitation sessions) and vital status at follow-up. One year after the fracture, either patients or relatives were contacted by telephone to ascertain their vital status. Data were analyzed using logistic regressions and multivariate Cox proportional hazards regression. RESULTS Three quarters of patients (76.0%) were able to comply with the Early Inpatient Exercise Program. Factors associated with adherence were: living at home (Odds Ratio (OR)=3.39; 95% Confidence Interval (CI): 2.03, 5.64), absence of pre-fracture disability (OR=3.78; 95% CI: 2.21, 6.47), absence of pre-fracture cognitive impairment (OR=2.36; 95% CI: 1.36, 4.07) and comorbidities (OR=1.66; 95% CI: 1.03, 2.67). Early Inpatient Exercise Program adherence was associated with one-year survival (HR=1.62; 95% CI: 1.06, 2.49). CONCLUSIONS The adherence with an Early Inpatient Exercise Program is high and is associated with 1-year survival. It is important to make a stronger effort to encourage participation in Early Inpatient Exercise Program in the 24% currently non-compliant, and in those with cognitive and physical impairments.
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Ariza-Vega P, Mora-Traverso M, Ortiz-Piña M, Ashe MC, Kristensen MT. Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture. Disabil Rehabil 2019; 42:2766-2771. [PMID: 30907173 DOI: 10.1080/09638288.2019.1577499] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: To translate the Cumulated Ambulation Score into Spanish, and to examine its inter-rater reliability, agreement and internal consistency.Materials and Methods: Two occupational therapists independently used the Spanish version of the Cumulated Ambulation Score (three activities scored from 0-2 points) to assess 60 consecutive patients with hip fracture within the first post-surgery week at a traumatology service of a public hospital. We used linear weighted kappa (κ) statistics to determine inter-rater reliability, percent agreement to assess measurement error, Cronbach's α coefficient to establish the internal consistency, and the McNemar-Bowker test to evaluate for systematic between-rater differences.Results: The κ was ≥ 0.83 for the three individual activities and the total score, the percent agreement was ≥ 0.87, and Cronbach's α was 0.89 with no observed systematic between-rater difference.Conclusions: This study provides evidence for almost perfect inter-rater reliability, excellent internal consistency, and high percent agreement of the Spanish version of the Cumulated Ambulation Score. Due to the strong psychometric properties, and its ease of use, we suggest it be used in Spanish speaking countries to assess early basic mobility status of patients with hip fracture until independence is reached.Implications for rehabilitationThe Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture.We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached.The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Physiotherapy, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | - Maureen Celeste Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark.,Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
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Aprato A, Casiraghi A, Pesenti G, Bechis M, Samuelly A, Galante C, Capitani D, Massè A. 48 h for femur fracture treatment: are we choosing the wrong quality index? J Orthop Traumatol 2019; 20:11. [PMID: 30758673 PMCID: PMC6375274 DOI: 10.1186/s10195-019-0518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. Materials and methods All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study. Exclusion criteria were patient age younger than 65 years, death before surgery, and nonsurgical treatment. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index (BMI), type and side of fracture, American Society of Anesthesiologists (ASA) score, date and time of surgery, surgical time, length of hospitalization, death during hospitalization, time from surgery to physiotherapy start, and time from surgery to first walking day. Results The study sample resulted in 660 patients. Mean age was 82 years, 64 % were female, mean BMI was 24 kg/m2, mean ASA score was 2.7, and 42 % were medial fractures. Mean time from admission to surgery was 95 h; 49.8 % were treated within the first 48 h. Mean time from surgery to physiotherapy start was 2 days, 21 % were not able to walk during hospitalization, time from surgery to first walking day was 5 days, and mean hospitalization time was 15 days. Early surgery was significantly (p = 0.008) associated with the probability of ambulation recovery during hospitalization. No association (p = 0.513) was found between early surgery and time in bed without walking. Conclusions Early surgery in femur fracture became a priority in the health system. However, according to our data, although 51 % of patients were treated within the first 48 h, time from surgery to physiotherapy start (2 days) was still too long. Furthermore, time from surgery to first walking day was 6 days, longer than in most published papers. These data suggest that the performance index (rate of femur fractures treated within 48 h) may be improved by changing it to rate of femur fractures surgically treated with return to walking in 96 h. Level of evidence Level 4 (retrospective study).
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Affiliation(s)
- Alessandro Aprato
- School of Medicine, University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy.
| | | | | | - Marco Bechis
- School of Medicine, University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
| | - Alessandro Samuelly
- School of Medicine, University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
| | | | | | - Alessandro Massè
- School of Medicine, University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
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Efficacy, cost, and aspects to take into account in the treatment of osteoporosis in the elderly. Rev Esp Geriatr Gerontol 2018; 54:156-167. [PMID: 30606499 DOI: 10.1016/j.regg.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
Age is one of the principal risk factors for development of frailty fractures. Age pyramids show a population that is becoming increasingly more elderly, with an increasing incidence of fractures, and the forecasts for the future are truly alarming. Adequate handling of these patients who are especially at risk, at both the preventive and care levels, with a well-defined orthogeriatric model is necessary to respond to this clinical challenge. The objective of this review is to analyze the efficacy of the different strategies for the handling of geriatric patients with fracture risk.
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Reguant F, Arnau A, Lorente JV, Maestro L, Bosch J. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth 2018; 53:11-19. [PMID: 30286380 DOI: 10.1016/j.jclinane.2018.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality. DESIGN A non-randomized intervention study with a historical control group (CG). SETTING During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge. PATIENTS 240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG). INTERVENTIONS CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care. MEASUREMENTS The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality. MAIN RESULTS 512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42-0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44-0.93) were the protective factors for mortality. CONCLUSIONS The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
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Affiliation(s)
- F Reguant
- Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain.
| | - A Arnau
- School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain; Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr, Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain
| | - J V Lorente
- Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - L Maestro
- Specialized Nursing in Anaesthesia, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain
| | - J Bosch
- School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain
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Sierra P, Gómez-Luque A, Llau JV, Ferrandis R, Cassinello C, Hidalgo F. Recommendations for perioperative antiplatelet treatment in non-cardiac surgery. Working Group of the Spanish Society of Anaesthesiology-Resuscitation and Pain Therapy, Division of Haemostasis, Transfusion Medicine, and Perioperative Fluid Therapy. Update of the Clinical practice guide 2018. ACTA ACUST UNITED AC 2018; 66:18-36. [PMID: 30166124 DOI: 10.1016/j.redar.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 12/24/2022]
Affiliation(s)
- P Sierra
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España.
| | - A Gómez-Luque
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Dr. Peset, Universitat de València, Valencia, España
| | - R Ferrandis
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hopital Clínic i Universitari La Fe, Universitat de València, Valencia, España
| | - C Cassinello
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - F Hidalgo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, España
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Molina Hernández MJ, González de Villaumbrosia C, Martín de Francisco de Murga E, Alarcón Alarcón T, Montero-Fernández N, Illán J, Bielza R, Mora-Fernández J. [Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]. Rev Esp Geriatr Gerontol 2018; 54:5-11. [PMID: 30131189 DOI: 10.1016/j.regg.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. MATERIAL AND METHOD This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). RESULTS The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. DISCUSSION Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.
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Affiliation(s)
| | | | | | | | - Nuria Montero-Fernández
- Servicio de Geriatría, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Julia Illán
- Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Rafael Bielza
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jesús Mora-Fernández
- Servicio de Geriatría, IdISSC, Hospital Universitario Clínico San Carlos, Madrid, España.
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Bielza R, Fuentes P, Blanco Díaz D, Moreno RV, Arias E, Neira M, Birghilescu AM, Sanjurjo J, Escalera J, Sanz-Rosa D, Thuissard IJ, Gómez Cerezo JF. [Assessment of clinical complications and their associated factors in hip-fracture patients in an Acute Geriatric Orthopaedic Unit]. Rev Esp Geriatr Gerontol 2018; 53:121-127. [PMID: 29486947 DOI: 10.1016/j.regg.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. MATERIAL AND METHODS A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). RESULTS A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P<.001) were factors associated with clinical complications. CONCLUSIONS Delirium, renal failure, and cardiac complications were the most frequent complications according the new recommendations. An ASA III-IV score, worse functional status at discharge, prolonged pre-operative period, and increased length of stay, were risk factors associated with clinical complications. Cardiac, pulmonary, and gastrointestinal complications were the main causes of mortality in the unit.
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Affiliation(s)
- Rafael Bielza
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | - Paola Fuentes
- Servicio de Geriatría, Hospital Naval A. Nef, Escuela de Medicina sede Viña del Mar, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, Valparaíso, Chile
| | - David Blanco Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ricardo Vicente Moreno
- Servicio de Rehabilitación, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Estefanía Arias
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Marta Neira
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ana M Birghilescu
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jorge Sanjurjo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Javier Escalera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - David Sanz-Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Israel J Thuissard
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Jorge F Gómez Cerezo
- Servicio de Medicina Interna-Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Sáez-López P, González-Montalvo JI, Ojeda-Thies C, Mora-Fernández J, Muñoz-Pascual A, Cancio JM, Tarazona FJ, Pareja T, Gómez-Campelo P, Montero-Fernández N, Alarcón T, Mesa-Lampre P, Larrainzar-Gar R, Duaso E, Gil-Garay E, Diéz-Pérez A, Prieto-Alhambra D, Queipo-Matas R, Otero-Puime A. Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation. Rev Esp Geriatr Gerontol 2018; 53:188-195. [PMID: 29426794 DOI: 10.1016/j.regg.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. DESIGN Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. STUDY SCOPE AND SUBJECTS: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. RESULTS It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition.
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Affiliation(s)
- P Sáez-López
- Hospital Universitario Fundación Jiménez Díaz, Madrid; Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid
| | - J I González-Montalvo
- Hospital Universitario La Paz, Madrid; Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid.
| | | | | | | | | | | | - T Pareja
- Hospital Universitario de Guadalajara, Guadalajara
| | - P Gómez-Campelo
- Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid
| | | | - T Alarcón
- Hospital Universitario La Paz, Madrid; Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid
| | | | - R Larrainzar-Gar
- Hospital Universitario Infanta Leonor. Facultad Medicina Universidad Complutense de Madrid, Madrid
| | - E Duaso
- Hospital de Igualada, Barcelona
| | - E Gil-Garay
- Hospital Universitario La Paz, Madrid; Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid
| | - A Diéz-Pérez
- Hospital del Mar. Barcelona. CIBER de Fragilidad y Envejecimiento Saludable, Instituto Carlos III
| | - D Prieto-Alhambra
- G Associate Professor & NIHR Clinician Scientist. NDORMS, University of Oxford. Grupo de Investigación GREMPAL, Idiap Jordi Gol y CIBERFes; Universitat Autònoma de Barcelona e Instituto de Salud Carlos III, Barcelona
| | - R Queipo-Matas
- Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid; Departamento de Farmacia y Biotecnología. Facultad de Medicina. Universidad Europea de Madrid
| | - A Otero-Puime
- Instituto de Investigación del Hospital La Paz. IdiPAZ, Madrid; Departamento de Medicina Preventiva y Salud Pública. Universidad Autónoma de Madrid, Madrid
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Muñoz-Pascual A, Sáez-López P, Jiménez-Mola S, Sánchez-Hernández N, Alonso-García N, Andrés-Sainz AI, Macias-Montero MC, Vázquez-Pedrezuela C, Pereira de Castro Juez N, Del Pozo-Tagarro P, Pablos-Hernández C, Cervera-Díaz C, Cerón-Fernández A, Vuelta-Calzada E, Perez-Jara Carrera J, González-Ramírez A, Collado-Díaz T, Idoate-Gil J, Guerrero-Díaz MT, Gutierrez-Bejarano D, Martín-Perez E. [Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)]. Rev Esp Geriatr Gerontol 2017; 52:242-248. [PMID: 28522074 DOI: 10.1016/j.regg.2017.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/12/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). MATERIAL AND METHOD The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. RESULTS The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. CONCLUSIONS Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register.
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Affiliation(s)
| | - Pilar Sáez-López
- Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España; Instituto de Investigación Hospital Universitario La Paz, Fundación Idi Paz, Ávila, España.
| | - Sonia Jiménez-Mola
- Unidad de Geriatría, Complejo Asistencial Universitario de León, León, España
| | | | | | | | | | | | | | | | | | - Carmen Cervera-Díaz
- Unidad de Geriatría, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | | | | | | | | | - Javier Idoate-Gil
- Unidad de Geriatría, Complejo Asistencial Universitario de León, León, España
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17
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Sáez-López P, Brañas F, Sánchez-Hernández N, Alonso-García N, González-Montalvo JI. Hip fracture registries: utility, description, and comparison. Osteoporos Int 2017; 28:1157-1166. [PMID: 27872956 DOI: 10.1007/s00198-016-3834-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/03/2016] [Indexed: 12/30/2022]
Abstract
UNLABELLED Hip fractures (HF) are prevalent and involve high morbidity and mortality so improving their management is important. HF registries are a good way to improve knowledge about this condition and its quality of care, while at the same time reducing clinical variability, optimizing efficiency, improving outcomes, and reducing costs. INTRODUCTION Hip fractures (HF) are a prevalent fragility fracture secondary to osteoporosis that involves high morbidity and mortality. They are low-impact fractures, resulting from a fall from a standing or sitting height. Despite numerous Clinical Practice Guidelines that establish uniform recommendations for their care, great variability persists regarding clinical and healthcare outcomes. Fracture registries can help detect deficits and establish measures to improve care. The objective of this work is to analyze the contents that a HF registry should have and to compare the characteristics of some national HF registries. METHODS A literature search was conducted on several national hip fracture registries, and those that contain relevant information on the variables and their outcomes were selected. RESULTS The selected HF registries were compared using the parameters they measure as well as the outcomes in the different countries. The variables collected in the majority of the databases and those that give useful information are as follows: sociodemographic variables (age, sex, place of residence), clinical variables (function before and after HF, anesthesia risk as measured by the ASA score, type of fracture, type of surgery and anesthesia, and in-hospital and 1-month mortality), and healthcare variables (pre-operative and overall stay, presence of collaboration with orthogeriatrics or with any clinician in addition to the surgeon, secondary prevention of new fractures by assessing the fall risk, and need for osteoporosis treatment). CONCLUSION The recording of HF cases in different countries improves knowledge about handling this condition and its quality of care, while at the same time reducing clinical variability, optimizing efficiency, improving outcomes, and reducing costs. The debate on the variables that should be recorded is timely, such as organizing how to collect each measurement, and even trying to unify the national and international registries or using a current proposal such as the one from the Fragility Fracture Network.
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Affiliation(s)
- P Sáez-López
- Geriatrics Unit, Complejo Asistencial Universitario, Avila, Spain
- Orthogeriatrics Working Group of the Castilla-Leon, Cantabria, and Rioja Society of Traumatology, Complejo Asistencial Universitario, Avila, Spain
| | - F Brañas
- Geriatrics and Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
- Madrid Geriatrics and Gerontology Society, Madrid, Spain.
| | - N Sánchez-Hernández
- Department of Traumatology, Complejo Asistencial Universitario, Avila, Spain
| | - N Alonso-García
- Department of Traumatology, Complejo Asistencial Universitario, Avila, Spain
| | - J I González-Montalvo
- Madrid Geriatrics and Gerontology Society, Madrid, Spain
- Hospital La Paz Research Foundation, IdiPAZ, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Geriatrics, Hospital Universitario La Paz, Madrid, Spain
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18
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Fernández-Ibáñez J, Morales-Ballesteros M, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes M, Cruz-Tejado J, Hernández-Zegarra P, Arias-Arias Á, García-Baltasar M. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes MD, Cruz-Tejado J, Hernández-Zegarra PA, Arias-Arias Á, García-Baltasar MM. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:88-95. [PMID: 28214194 DOI: 10.1016/j.recot.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.
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Affiliation(s)
- J M Fernández-Ibáñez
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - M C Morales-Ballesteros
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - E Crespo-Romero
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - S Gómez-Gómez
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M D Fraga-Fuentes
- Servicio de Farmacia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Cruz-Tejado
- Servicio de Anestesia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P A Hernández-Zegarra
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Á Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M M García-Baltasar
- Servicio de Trabajo Social, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Alonso-Fernández P, Romero E, Chung M, García-Salmones M, Cabezas P, Mora J. Delayed surgery in hip fracture patients. Can we afford it? Int J Health Plann Manage 2016; 32:653-659. [PMID: 27139300 DOI: 10.1002/hpm.2353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/05/2016] [Accepted: 03/21/2016] [Indexed: 11/12/2022] Open
Abstract
The aim is to analyze whether time to surgery (TtoS) in hip fracture patients is associated with longer than expected length of stay (LofS) and whether there is any particular group in which this is especially relevant. We developed an observational study in Madrid, Spain. From 771 patients admitted to the orthopedic ward, we selected 723 with surgical delay ≤7 days. Age was characterized as younger (<81), elderly (81-90), very elderly (>90). Modified Barthel Index was classified as very dependent (<41), moderately dependent (41-80), independent (>80). RESULTS Median (IQR) TtoS was 3 (1-4) days; LofS 12 (7-15). Mean age was 84.3 years, 78.4% were women. TtoS was associated with LofS, which increased by 1.80 days (95% CI, 1.50-2.10) per delayed day (p<0.001). After adjustment for age, sex, functional status, we found an increase of 1.75 days (1.46-2.04) per day (p<0.001). We did not find effect of age or sex. Functional status had a higher effect in moderately dependent patients 2.25 days (1.78-2.72) than in very dependent or independent patients, 1.33 (0.37-2.30) and 1.50 days (1.09-1.91) respectively (p 0.012). As conclusion we could affirm that increasing TtoS leads to longer than expected LofS in hip fracture patients, particularly moderately dependent patients. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Elena Romero
- Hospital Clinico San Carlos, Geriatrics, Madrid, Spain
| | - Monica Chung
- Hospital Clinico San Carlos, Geriatrics, Madrid, Spain
| | | | - Pilar Cabezas
- Hospital Clinico San Carlos, Geriatrics, Madrid, Spain
| | - Jesús Mora
- Hospital Clinico San Carlos, Geriatrics, Madrid, Spain
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Sánchez-Hernández N, Sáez-López P, Paniagua-Tejo S, Valverde-García J. Results following the implementation of a clinical pathway in the process of care for elderly patients with osteoporotic hip fracture in a second level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mesa-Lampré M, Canales-Cortés V, Castro-Vilela M, Clerencia-Sierra M. Initial experiences of an orthogeriatric unit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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[Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:1-11. [PMID: 26493233 DOI: 10.1016/j.recot.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/16/2015] [Accepted: 08/17/2015] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. MATERIAL AND METHODS A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. RESULTS The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. CONCLUSION The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.
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Clerencia-Sierra M, Calderón-Larrañaga A, Martínez-Velilla N, Vergara-Mitxeltorena I, Aldaz-Herce P, Poblador-Plou B, Machón-Sobrado M, Egüés-Olazabal N, Abellán-van Kan G, Prados-Torres A. Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes. PLoS One 2015. [PMID: 26208112 PMCID: PMC4514748 DOI: 10.1371/journal.pone.0132909] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES The clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting. DESIGN Retrospective observational study. SETTING Unit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital (HUMS), Zaragoza (Spain). Year, 2011. PARTICIPANTS A total of 924 hospitalized patients aged 65 years or older. MEASUREMENTS Data on patients' clinical, functional, cognitive and social statuses were gathered through comprehensive geriatric assessments. To identify diseases and/or geriatric syndromes that cluster into patterns, an exploratory factor analysis was applied, stratifying by sex. The factors can be interpreted as multimorbidity patterns, i.e., diseases non-randomly associated with each other within the study population. The resulting patterns were clinically assessed by several physicians. RESULTS The mean age of the study population was 82.1 years (SD 7.2). Multimorbidity burden was lower in men under 80 years, but increased in those over 80. Immobility, urinary incontinence, hypertension, falls, dementia, cognitive decline, diabetes and arrhythmia were among the 10 most frequent health problems in both sexes, with prevalence rates above 20%. Four multimorbidity patterns were identified that were present in both sexes: Cardiovascular, Induced Dependency, Falls and Osteoarticular. The number of conditions comprising these patterns was similar in men and women. CONCLUSION The existence of specific multimorbidity patterns in geriatric patients, such as the Induced Dependency and Falls patterns, may facilitate the early detection of vulnerability to stressors, thus helping to avoid negative health outcomes such as functional disability.
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Affiliation(s)
- Mercedes Clerencia-Sierra
- Unit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital, Zaragoza, Spain
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- * E-mail:
| | - Nicolás Martínez-Velilla
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Geriatric Service, Hospital Complex of Navarra, Navarra Health Service—Osasunbidea, Pamplona, Spain
| | - Itziar Vergara-Mitxeltorena
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Research Unit AP-OSIS Gipuzkoa, IIS Biodonostia, San Sebastián, Spain
| | - Pablo Aldaz-Herce
- San Juan Health Center, Navarra Health Service—Osasunbidea, Pamplona, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Mónica Machón-Sobrado
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Research Unit AP-OSIS Gipuzkoa, IIS Biodonostia, San Sebastián, Spain
| | | | - Gabor Abellán-van Kan
- Frailty Day-Hospital, Gérontopôle de Toulouse, Department of Geriatric Medicine, CHU de Toulouse-Purpan, Toulouse, France
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
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25
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Sáez López P, Sánchez Hernández N, Paniagua Tejo S, Valverde García JA, Montero Díaz M, Alonso García N, Freites Esteve A. [Clinical pathway for hip fracture patients]. Rev Esp Geriatr Gerontol 2015; 50:161-167. [PMID: 25559411 DOI: 10.1016/j.regg.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. PURPOSE To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. MATERIAL AND METHODS A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. RESULTS Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. CONCLUSION The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.
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Affiliation(s)
- Pilar Sáez López
- Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España.
| | | | | | | | - Margarita Montero Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Noelia Alonso García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Alfonso Freites Esteve
- Servicio de Cardiología. Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Mesa-Lampré MP, Canales-Cortés V, Castro-Vilela ME, Clerencia-Sierra M. [Initial experiences of an orthogeriatric unit]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:429-38. [PMID: 25920894 DOI: 10.1016/j.recot.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To report the design and outcomes obtained during the first operational years of the Orthogeriatric Unit (OGU) established in the Zaragoza-1 (Spain) Health-Sector. MATERIAL AND METHODS A total of 494 patients >70 years old treated in the OGU from February 2009 to December 2012. An analysis was performed using the following variables: demography, previous functional level, comorbidities, surgical delay, fracture type and surgical technique, complications, hospital stay, functional outcomes, destination after hospital discharge, and short and long term mortality. RESULTS Mean age 85.22 years. High incidence of comorbidities (Charlson Index): 24.3%. Dementia: 38.5%. Surgical delay: 2.57 days. Mean hospital stay between admission and discharge/transfer to convalescence unit, 20.9 days (Traumatology 6.45+OGU 14.49). More than a third (34.6%) of patients suffered from delirium. Mean functional improvement (Barthel index at hospital discharge-Barthel index at hospital admission): 27.25 points. Montebello index: 0.49. In-hospital mortality: 6.9%. CONCLUSION Hip fracture is such a frequent and disabling pathology among the geriatric population that its treatment requires an interdisciplinary approach. This must be managed by the geriatrician, who has to assure the continuity and integration of the diverse treatment and care schedules, with the participation of the entire professional team in the decision-making process. We are very satisfied with the creation of our interdisciplinary Unit that enables us to report competitive outcomes. We believe that the progression of this Unit from providing subacute to acute care will improve the general outcomes in the future.
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Affiliation(s)
- M P Mesa-Lampré
- Servicio de Geriatría, Unidad de Ortogeriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - V Canales-Cortés
- Servicio de Cirugía Ortopédica y Traumatología, Sector Zaragoza 1, Unidad de Ortogeriatría, Hospitales Royo Villanova y Nuestra Señora de Gracia, Zaragoza, España.
| | | | - M Clerencia-Sierra
- Unidad de Valoración Sociosanitaria, Hospital Universitario Miguel Servet, Zaragoza, España
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Factors Associated With Short-Term Functional Recovery in Elderly People With a Hip Fracture. Influence of Cognitive Impairment. J Am Med Dir Assoc 2015; 16:215-20. [DOI: 10.1016/j.jamda.2014.09.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 01/21/2023]
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Pareja Sierra T, Rodriguez Solis J. Tratamiento médico perioperatorio del anciano ingresado por fractura de cadera. Med Clin (Barc) 2014; 143:455-60. [DOI: 10.1016/j.medcli.2014.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/29/2022]
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González-Montalvo JI, Alarcón Alarcón T. [Orthogeriatrics in acute patients: to act, but also assess and compare as a way to improve]. Rev Esp Geriatr Gerontol 2014; 49:101-2. [PMID: 24656718 DOI: 10.1016/j.regg.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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[Orthogeriatric activity in public hospitals of Castilla y León: description and review of the literature]. Rev Esp Geriatr Gerontol 2014; 49:137-44. [PMID: 24565685 DOI: 10.1016/j.regg.2014.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 01/04/2023]
Abstract
The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.
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Comprehensive care program for elderly patients over 65 years with hip fracture. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2013.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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32
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Malafarina V, Uriz-Otano F, Gil-Guerrero L, Iniesta R, Zulet MA, Martinez JA. Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study. Maturitas 2013; 76:123-8. [DOI: 10.1016/j.maturitas.2013.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/06/2013] [Accepted: 06/08/2013] [Indexed: 12/19/2022]
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Fernández-Moyano A, Fernández-Ojeda R, Ruiz-Romero V, García-Benítez B, Palmero-Palmero C, Aparicio-Santos R. Comprehensive care program for elderly patients over 65 years with hip fracture. Rev Clin Esp 2013; 214:17-23. [PMID: 23541310 DOI: 10.1016/j.rce.2013.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/14/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. PATIENTS AND METHODS We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. RESULTS One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. CONCLUSIONS This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery.
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Affiliation(s)
- A Fernández-Moyano
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
| | - R Fernández-Ojeda
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - V Ruiz-Romero
- Departamento de Calidad Asistencial, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - B García-Benítez
- Servicio de Traumatología y Ortopedia, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - C Palmero-Palmero
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - R Aparicio-Santos
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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